Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy

Dayaratna, Sandra; Goldberg, Jay; Harrington, Christine; Leiby, Benjamin E.; McNeil, Jean

doi:10.1016/j.ajog.2013.09.028

Cited by 53 publications

(30 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its advantages being early ambulation, early oral feeds, going to the toilet the very next day, less complications, and no expensive equipments and machines required. It was observed that the cost of care includes not only the medications and surgical fees, but also the productive work day lost [15]. Hence, NDVH is a better choice in rural perspective where women are employed in various activities on daily wages.…”

Section: Discussionmentioning

confidence: 99%

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Jain

Chandrakar

2016

J Obstet Gynecol India

View full text Add to dashboard Cite

Objective NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient. Methods This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital.Women were counselled on the basis of 'PREPARED' questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed. Results We observed that there was a little awareness about NDVH and its outcome among the subjects. Ten out of 100 patients refused to perform NDVH after counselling and underwent TAH. Rest of the 90 patients opted for NDVH. Forty out of 90 patients were aware about NDVH, but they were sceptical about the outcome, and 50 were totally unaware. After applying 'PREPARED' questionnaire and counselling, we could motivate them to accept NDVH. It was successful in all cases except one where laparotomy was done for ovarian artery retraction. With no significant post-operative complications, early return to routine activity and low cost of surgery, all patients were satisfied with surgical outcome and improved quality of life. 123 the procedure. Most of the abdominal hysterectomy can be converted successfully to NDVH in technically feasible cases by experienced hands so adequate training to gynaecology residents is the need of the time. NDVH is economical to the patient as well as for the healthcare system.

show abstract

Section: Discussionmentioning

confidence: 99%

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Jain

Chandrakar

2016

J Obstet Gynecol India

View full text Add to dashboard Cite

show abstract

“…Dayartna et al performed an analysis of total hospital costs for minimally-invasive hysterectomy routes from 2007-2010 at a single academic institution and found robotic-assisted hysterectomy to be the most expensive route at $13,429, followed by conventional laparoscopy ($11,558), vaginal with laparoscopy ($10,069), and vaginal ($7,903). 11 Purchase cost of the robot (approximately $2.5 million) was not included in this estimate. 10 Mean weighted average cost of the non-robotic MIS hysterectomy routes was $10,084 per case.…”

Section: Resultsmentioning

confidence: 99%

“…Our results regarding cost are consistent with published data showing significantly increased costs with robotic-assisted hysterectomy. 4,[8][9][10][11][12] As surgeons, we have an obligation to consider the cost-benefit ratio of our interventions and balance our goals of optimizing clinical outcomes and practicing good stewardship of our healthcare resources.…”

Section: Commentmentioning

confidence: 99%

“…[3][4][5][6][7] Although cited benefits of the robotic-assisted route over conventional laparoscopy include lower estimated blood loss and shorter length of stay, complication rates appear to be similar and costs significantly higher with robotic technology. 4,[8][9][10][11][12] Vaginal hysterectomy remains the preferred route when possible and is recommended as such by the American Congress of Obstetricians and Gynecologists. 13 However, few comparative studies of robotic hysterectomy actually include vaginal approaches.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

6: Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications

Swenson

Kamdar

Morgan

2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…Several publications have compared costs among the various surgical approaches, consistently favoring vaginal surgery (12,28,29). In January 2015, United HealthCare Services, Incorporated, released a network bulletin outlining changes in the company's requirements for preauthorization of hysterectomy procedures (30).…”

Section: Discussionmentioning

confidence: 99%

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Schmitt

Carranza

Weaver

et al. 2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Objective-To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.Methods-A retrospective post-robot cohort of benign hysterectomies (2009)(2010)(2011)(2012)(2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded laparoscopic hysterectomy route. A prerobot cohort (2004)(2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated.Results-Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the pre-robot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy, with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the post-robot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%), robot-assisted; and 136 (11.4%), abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when vaginal approach was expected. Robotic hysterectomies had longer operations (141 vs 59 minutes, P<.001) and higher rates of surgical site infection (4.7% vs 0.2%, P<.001) and urinary tract infection (8.1% vs 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years.Conclusion-When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible. Financial Disclosure: Dr. Gebhart has served on the advisory board for Astora and received royalties from UpToDate, Inc, and Elsevier BV. The other authors did not report any potential conflicts of interest. Graphical Abstract HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAn algorithm can be used for decision-making in determining the most appropriate route of hysterectomy to optimize patient outcomes and lower health care delivery costs.

show abstract

Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy

Cited by 53 publications

References 7 publications

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

6: Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Contact Info

Product

Resources

About